On April 18, 2022, we submitted our response to CMS’ Request for Information on Medicaid and CHIP. We look forward to working with CMS to strengthen the Medicaid and CHIP programs for children and the providers who care for them. In the areas of eligibility and enrollment, access and payment, we made several recommendations. Below are highlights of our recommendations based on feedback from children’s hospitals:
Eligibility and enrollment
- Streamline eligibility and enrollment processes as a critical step to assuring access to care.
- Require timely redeterminations of eligibility.
- Enforce timely enrollment into managed care.
- Support legislative changes to take further steps on eligibility and access to care, including requiring 12-month continuous coverage for children.
- Align public assistance data systems and encourage increased coordination across state agencies.
- Clarify ongoing returned mail standards and notice requirements, including multiple communication modalities.
- Enhance support for application assisters, enhanced outreach and staffing to assist with redeterminations.
- Eliminate or disallow periodic data checks.
- Expand error reporting, monitoring of denials and track disenrollment data.
Access and payment
- Require managed care organizations under Medicaid to include full range of pediatric specialty services.
- Move toward more data-driven oversight of children’s access to care at both the federal and state level.
- Ensure adequate payment that supports access to care.
- Take action to reduce the unnecessary administrative burdens that can delay care and increase costs for providers.
- Conduct oversight of the Early and Periodic Screening, Diagnosis and Treatment benefit for children to ensure consistent application to support access to needed care across states.
- Address the many challenges for children who need to travel outside their home state for care.
- Encourage continued use of telehealth to support children’s access to care.
